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�.�� ��� Impact Valve <br /> ogy Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2387480 Date: 1/6/2026 <br /> Site Name/ID: CHEVRON #201383 (N-2515-1-1) <br /> Address: 1960 W. 11TH STREET @ CORRAL HOLLOW <br /> City: TRACY State: CA Zip: 95376 <br /> How Inspected: Line Test NFPA 30A r- PEI RP1200W Other F <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 r FY-1 r Pass F Fail r Not Tested <br /> 1/2 91 r r W Pass F Fail r Not Tested <br /> 3/4 87 r FV- r Pass F Fail r Not Tested <br /> 3/4 91 r r W Pass F Fail r- Not Tested <br /> 5/6 87 r r ry-' Pass F Fail r- Not Tested <br /> 5/6 91 r F70 r Pass r- Fail r Not Tested <br /> 7/8 87 W W r Pass F Fail r Not Tested <br /> 7/8 91 r F7 rv- Pass F Fail r Not Tested <br /> 9/10 40 r r W Pass F Fail r- Not Tested <br /> 9/10 87 r r r Pass F Fail r Not Tested <br /> 9/10 91 r r W Pass F Fail r- Not Tested <br /> 11/12 40 r r r Pass r Fail r Not Tested <br /> 11/12 87 I7 F7 P0 Pass r- Fail r- Not Tested <br /> 11/12 91 FY r W1 Pass F Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jesus Saldivar <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2026 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />